World Anaesthesia Day – The Day of No Pain

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Mohd Faeiz Pauzi, MD, MMed Anaes, PGDip Pain Intervention

 
 

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"First Operation Under Ether" painting by Robert C. Hinckley. Courtesy of the Boston Medical

Library in the Francis A. Countway Library of Medicine 

 

16 October 1846, the first public demonstration of ether anaesthesia took place at the Massachusettes General Hospital, Boston. On 2012, New England Journal of Medicine (NEJM) readers agree that an 1846 report on the discovery of ether anaesthesia was “the most important article” in the prestigious medical journal’s 200-year history. 

 

William Thomas Green Morton, a dentist from Boston, America, tested the use of ether on himself to understand how it stopped pain. On 30th  September 1846, he used ether to remove a patient’s tooth, and the patient said it didn’t hurt. Morton was asked to publicly demonstrate this technique, and later on 16th  October 1846 he successfully used ether for the removal of a tumour on patient Gilbert Abbott’s neck. Edward Gilbert Abbott (1825-55), was the first official anaesthetic patient, was operated by surgeon John Collins Warren. A portion of a vascular tumour was removed from Abbott’s neck. The operation was done in an amphitheater at the Massachusetts General Hospital, and now the place known as the Ether Dome. 

 

Among the doctors who watched the demonstration on 16th Oct were father and son Professor Jacob Bigelow and Dr Henry Bigelow. Henry Bigelow was a surgeon at the Massachusetts General Hospital and he wrote a report on the operation which was printed in the Boston Daily Advertiser newspaper on 19th November 1846. Professor Jacob Bigelow wrote to his old friend and colleague Dr Francis Boott, describing the operation he had just witnessed. On 28th  November 1846, he put this letter, along with a copy of the article from the Boston Daily Advertiser, and sent it to Boott in London. The parcel was shipped by Acadia from New York to Liverpool on 3th December 1846 and docks in Liverpool on 16 December. Then it mades the way to Dr Boott in London. 

 

On 19th December 1846, dentist James Robinson, Francis Boott and Francis’s niece Miss Lonsdale, all met in Francis’s study at 24 Gower Street, London. James Robinson used this piece of equipment for the procedure. It’s known as a Nooth’s apparatus and the sponge would have been soaked in ether and Miss Lonsdale would have breathed that in through the face piece. Originally, this piece of equipment was made to reproduce natural spa water for medicinal uses, but on this day James Robinson used this equipment to remove a tooth from Miss Lonsdale. Hence, just three months after the first recorded ether anaesthetic in Bonston, James Robinson, and England, is credited with the first recorded use of ether in Europe. On the same day, there is a claim that ether was used in Dumfries in Scotland. Acadia’s surgeon William Fraser heard new of Morton's discovery whilst on the ship. Once home in Dumfries, Fraser persuaded his colleagues to operate on a patient under ether. However, it was not recorded. And that’s why England is credited with the first recorded use of ether in Europe.  

 

Today, anaesthesiologists are the most qualified to make anaesthesia related perioperative medical decisions. Anaesthesiologists are medical doctors specialized in anaesthesia care, pain management and critical care medicine. We are primarily responsible for the safety and wellbeing of patients before, during and after surgery. This was includes placing patients in the state of controlled unconscious called general anaesthesia, provision of regional anaesthesia where only a portion of the body is made numb, or administering sedation for the relief of pain or anxiety. We are also responsible for the well-being of the patient postoperatively. 

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Anaesthesiologist working closely with the surgeon for patient safety and wellbeing (photo taken before COVID-19 pandemic).  

From ether to more complicated anaesthetic machine. 

 

The role of anaesthesiologists extends beyond the operating room. We provide continuous pain relief and sustain patient’s critical life functions. We are often involved in the management of acute postoperative pain, as well as chronic and cancer pain; in cardiac and respiratory resuscitation; in blood transfusion therapies; and in respiratory therapy.  

 

During the unprecedented pandemic, the anaesthesiologists are essential in various critical aspects of the response to the outbreak of COVID-19. Earlier invasive ventilation, establishment of airway management teams and fast response resuscitation teams, and use of point-of-care ultrasonography are major contributions. With the change in epidemiologic characteristics of COVID-19 patients, anaesthesiologists took on the responsibility on infection control as well. 

 

This year, World Federation of Societies of Anaesthesiologists (WFSA) are asking anaesthesiologists around the world on Friday 16th  October to take part in World Anaesthesia Day 2020 campaign to highlight the importance of occupational wellbeing to anaesthesia. There is a link between occupational health and patient safety, with occupational fatigue being one of the main factors in a high prevalence of crisis. Successful organizational, professional, and personal interventions may dramatically enhance the health and wellbeing of anaesthesiologists and reduce the stress levels, depression and intentions to commit suicide. IT’S OK TO CONSIDER OUR OWN WELLBEING.

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Anaesthesiologist also involve in pain management (genicular nerve radiofrequency ablation for chronic knee pain).

 

 

References;

1. H.J. Bigelow. 1846. Insensibility during Surgical Operations Produced by Inhalation. The New England Journal of Medicine.36(16), 309-317.DOI: 10.1056/NEJM184611180351601

2. https://www.woodlibrarymuseum.org/history-of-anesthesia/

3. https://www.wfsahq.org

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Dr. Mohd Faeiz Pauzi is a medical lecturer from Anaesthesiology Unit, Faculty of Medicine, Universiti Sultan Zainal Abidin and National Specialist Register (NSR) in Anaesthesiology & Critical Care.